Provider Demographics
NPI:1760406920
Name:DEVELDER, JOAN (MSW)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:
Last Name:DEVELDER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 KINGSBERRY DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-4305
Mailing Address - Country:US
Mailing Address - Phone:732-246-1458
Mailing Address - Fax:
Practice Address - Street 1:29 CLYDE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5040
Practice Address - Country:US
Practice Address - Phone:732-545-5343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00183500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDE670425Medicare ID - Type UnspecifiedMEDICARE NUMBER